Influence of occupational dysfunction on the psychological problem in healthcare workers: A study using structural equation modeling

Purpose: This study identified the effect of occupational dysfunction on psychological factors of stress response, burnout syndrome, and depression in healthcare workers.

Method: Three cross sectional studies were conducted to assess the following relations: 1) occupational dysfunction on stress response (n = 468), 2) occupational dysfunction on burnout syndrome (n = 1142), and 3) occupational dysfunction on depression (n = 687). Personal characteristics were collected through a questionnaire (such as age, gender, and job category, opportunities for refreshment, time spent on leisure activities, and work relationships) as well as the Classification and Assessment of Occupational Dysfunction (CAOD). Furthermore, study 1 included the Stress Response Scale-18 (SRS-18), study 2 used the Japanese Burnout Scale (JBS), and study 3 employed the Center for Epidemiological Studies Depression Scale (CES-D). The Kolmogorov–Smirnov test, confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and path analysis of structural equation modeling (SEM) analysis were used in all of the studies. EFA and CFA were used to measure structural validity of four assessments; CAOD, SRS-18, JBS, and CES-D. For examination of a potential covariate, we assessed the correlation of the total score of CAOD and personal factors in all studies. Moreover, direct and indirect effects of occupational dysfunction on stress response (Study 1), burnout syndrome (Study 2), and depression (Study 3) were also analyzed.

Results: CAOD had 16 items and 5 factors. SRS-18 had 18 items and 3 factors, JBS had 17 items and 3 factors, CES-D had 20 items and 4 factors. All studies found that there were significant correlations between the CAOD total score and the personal factor that included opportunities for refreshment, time spent on leisure activities, and work relationships (p<0.01). The causal sequence model results suggest that the classification of occupational dysfunction had positive causal effects on the stress response (RMSEA = 0.058, CFI = 0.951, and TLI = 0.947), burnout syndrome (RMSEA = 0.074, CFI = 0.922, and TLI = 0.915), and depression (RMSEA=0.059, CFI=0.926, TLI=0.920). Moreover, the positive effect of external covariates include opportunities for refreshment, time spent on leisure activities, and work relationships on occupational dysfunction.

Conclusion: The classification of occupational dysfunction indicated a possibility of increase in the stress response, burnout syndrome, and depression in healthcare workers. Furthermore, occupational dysfunction affected personal factors including opportunities for refreshment, time spent on leisure activities, and work relationships. Therefore, it is necessary to adopt occupational therapy strategies to prevent this problem.